Retinal Artery Occlusion Follow-up

  • Author: Neil Jain, MD; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Apr 13, 2012
 

Further Inpatient Care

  • Further inpatient care is indicated only if comorbid disease is present.
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Further Outpatient Care

  • Patients should have serial evaluation of visual acuity by an ophthalmologist.
  • An ophthalmologist should perform evaluation for subsequent neovascularization of the iris or retina.
  • If HBO is to be used, several treatments may be necessary.
  • Patients require urgent follow up for carotid and cardiac evaluation to preclude further central retinal artery occlusion (CRAO) or stroke.
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Inpatient & Outpatient Medications

  • Inpatient or outpatient medications are indicated only if comorbid disease is present.
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Transfer

  • Transfer to a hyperbaric facility is necessary if hyperbaric oxygen is to be administered.
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Deterrence/Prevention

  • Patients should keep their blood pressure under control, lower their cholesterol, avoid IV drugs, and take their medication.
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Complications

  • Further emboli to brain resulting in CVA
  • Further emboli to the same or contralateral eye, resulting in further visual loss
  • Progression of temporal arteritis, resulting in loss of vision to the contralateral eye
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Prognosis

  • Recovery of useful vision is related directly to the rapidity of treatment and presenting visual acuity.
  • Studies report that 21% of patients exhibited visual improvement of 6 gradients of visual acuity, 35% exhibited improvement of 3 gradients of visual acuity, while 26% showed no improvement in visual acuity.
  • Patients that showed improvement had presenting visual acuity of counting fingers and a mean duration of visual loss of 21.1 hours; those that did not improve had presenting visual acuity of hand movement and a mean duration of visual loss of 58.6 hours.
  • The longest delay to treatment that has been associated with significant visual recovery is approximately 72 hours.
  • Presence of a cilioretinal artery with foveolar sparing increases improvement of visual acuity.
  • Branch retinal artery occlusions (BRAOs) are associated with a higher recovery rate (80% of eyes improve to 20/40 or better) than central retinal artery occlusions (CRAOs).
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Patient Education

  • Patients must understand that the prognosis for visual recovery is poor and that the visual changes are usually a result of a systemic process that needs treatment.
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Contributor Information and Disclosures
Author

Neil Jain, MD  Staff Physician, Yale University School of Medicine, Department of Surgery, Section of Emergency Medicine

Neil Jain, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Pascal SC Juang, MD  Medical Director, ED Information Systems, Department of Emergency Medicine, Hoag Memorial Hospital Presbyterian

Pascal SC Juang, MD, is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Assaad J Sayah, MD  Chief, Department of Emergency Medicine, Cambridge Health Alliance

Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas Lavenburg, MD  Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems

Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Kilbourn Gordon III, MD, and Enoch Huang, MD, to the development and writing of this article.

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The cherry red spot of central retinal artery occlusion.
 
 
 
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